When you hear “aloe” or “aloe vera,” what likely comes to mind first are sunburns or skin burns in general. And for good reason—soothing inflamed skin is aloe’s main claim to fame, but this long-celebrated medicinal plant’s properties and potential applications go far beyond this. Let’s explore some additional and lesser-known roles for aloe.

Recent years have seen a surge in interest in the gut microbiome and how it both affects and is affected by various disease states. It’s believed that short chain fatty acids (SCFAs) produced as a byproduct of colonic bacteria fermenting dietary fibers have important signaling functions and may play a role in the gut-associated immune response. In particular, butyric acid (a.k.a. butyrate) may be beneficial for brain health and is also believed to contribute to reduced inflammation in the gut and the noted association between high-fiber diets and reduced risk for colon cancer. In vitro research has shown that aloe vera has prebiotic effects when incubated with human gut bacterial cultures. A culture of mixed bacteria incubated with aloe vera showed a linear increase in butyric acid production, and production of acetic acid was increased when aloe vera was incubated with Bifidobacterium infantis. Increasing intake of dietary fiber is an obvious way to support production of these important SCFAs, but for individuals for whom increased fiber may bring negative consequences, supplementing with aloe vera may be an alternative strategy.

Aloe’s prebiotic effects are due to the chemical structure of some of its carbohydrate components. Aloe vera gel is composed of about 55% polysaccharides, including a compound called acemannan (a polymer of glucose and mannose), which, along with other polysaccharides in aloe, is believed to be a major contributor to aloe’s prebiotic and gut-supportive effects. Acemannan contains sugar molecules linked by β‐1→4 glycosidic bonds, which are not digestible by human enzymes. Intestinal bacteria, however, can cleave this bond, making acemannan digestible by the colonic flora. Another aloe compound, barbaloin, contains other bonds inaccessible to human digestive enzymes but cleavable by GI flora.

Aloe supplementation may be beneficial in the fight against type 2 diabetes. In a study out of India, non-insulin-dependent diabetics taking 100 mg or 200 mg of aloe vera gel powder daily for three months showed substantial improvement in several markers of glycemic control and cardiometabolic health. During an additional three months of supplementation to which nutritional counseling was added, not surprisingly there was even greater improvement beyond what the aloe alone had accomplished, but significant changes had occurred with the aloe use even in the absence of the counseling. Such changes included a 15% reduction in fasting glucose, a nearly 28% reduction in postprandial glucose, 12% reduction in triglycerides, 14% reduction in LDL-C, and a 9% increase in HDL-C among subjects taking 200 mg of aloe per day. (Smaller but still impressive improvements were seen in subjects taking 100 mg.)

These findings add to those from an earlier study that also showed Improvement in biomarkers of cardiometabolic health from aloe supplementation. The earlier study involved subjects with prediabetes or metabolic syndrome given standardized aloe extracts for eight weeks. One group was supplemented with aloe vera inner-leaf gel powder and the other group was treated with the same compound standardized with 2% aloesin (a powerful antioxidant in aloe). Compared to placebo, the inner-leaf gel powder led to significant reductions in total cholesterol and LDL-C, fasting glucose and fructosamine. The gel powder standardized with aloesin packed a bit more punch: subjects taking the latter experienced significant reductions in fasting glucose, insulin, HbA1c, fructosamine and HOMA-IR.

A more recent study confirms that aloe supplementation may help improve glycemic control and lipid profiles in subjects with prediabetes. Compared to placebo, aloe vera given at 300 mg daily helped reduce fasting glucose within four weeks, and HbA1c was decreased within eight weeks. A higher dose—500 mg—was shown to result in decreased triglycerides, total cholesterol and LDL-C, with an increase in HDL. (It’s important to note, however, that the role of LDL-C in cardiovascular disease and the merits of lowering LDL-C with statins are currently topics of intense debate.) Low-carbohydrate and ketogenic diets are highly effective for improving blood glucose and insulin in those with type 2 diabetes, but aloe supplementation could be a powerful adjunct even in the absence of dietary change for those who have difficulty sticking to a strict low-carb regimen.

All aloe is not created equal. Environmental conditions appear to exert a substantial influence on the concentration of various phytochemicals and phenolics. A study that compared antioxidant activity of aloe samples from several different regions in India determined that aloe from more tropical climates had lower antioxidant activity than samples from highland and semi-arid zones, which had the maximum. This raises interesting questions not only for the sourcing of medicinal aloe, but also for how changes in global climate might affect the bioactive compounds in the plant, similar to concerns about potential changes in anthocyanin content and other aspects of wine.

It’s long been known that aloe applied topically is effective for addressing various skin ailments. Now the benefits of taking aloe orally are starting to gain recognition.